Articles

Platinum Priority – Benign Prostatic Obstruction
Editorial by Peter J. Gilling on pp. 868–869 of this issue

Complications and Early Postoperative Outcome in 1080 Patients After Thulium Vapoenucleation of the Prostate: Results at a Single Institution eulogo1

By: Andreas J. Grossa , Christopher Netscha lowast , Sophie Knippera, Jasmin Hölzela and Thorsten Bacha b

European Urology, Volume 63 Issue 1, May 2013, Pages 859-867

Published online: 01 May 2013

Keywords: Benign prostatic obstruction, Morbidity, Mortality, Tm:YAG, ThuVEP, Thulium vapoenucleation of the prostate, Vapoenucleation

Abstract Full Text Full Text PDF (275 KB)

Abstract

Background

Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO).

Objective

To analyze immediate outcomes and the institutional learning curve of ThuVEP, and to report its standardized complication rates, using the modified Clavien classification system (CCS) to grade perioperative complication rates.

Design, settings, and participants

A prospective evaluation of 1080 patients undergoing ThuVEP from January 2007 until May 2012 at our institution.

Intervention

ThuVEP was performed using the 2-μm, continuous-wave, thulium:yttrium-aluminum-garnet laser.

Outcome measurements and statistical analysis

Preoperative status, surgical details, and immediate outcome were recorded for each patient. Perioperative complications were classified according to the modified CCS.

Results and limitations

Median prostate size was 51ml (interquartile range [IQR]: 36–78.7). Median operation time was 56min (IQR: 40–80), and median enucleation time was 32.5min (IQR: 22-50). Median catheterization time was 2 d (IQR: 2–2); median length of hospital stay was 4 d (IQR: 3–5). Median resected tissue weight was 30g (IQR: 16.00–51.25). Incidental carcinoma of the prostate was detected in 59 (5.5%) patients. Median maximum urinary flow rate (8.9 vs 18.4ml/s) and postvoid residual urine volume (120 vs 20ml) changed significantly (p<0.001). Minor complications occurred in 24.6% of the patients (Clavien 1: 20.8%; Clavien 2: 3.8%). Early reinterventions were necessary in 6.6% of the patients (Clavien 3a: 0.6%; Clavien 3b: 6%). One Clavien 4 complication occurred (0.09%). The overall complication rates decreased significantly over time due to decreasing Clavien 1, 2, and 3b events. The major limitations of the study are the prospective, unicentric study design, the lack of a control group, and that only short-term data were documented on morbidity and efficacy of the ThuVEP procedure.

Conclusions

ThuVEP is a safe and effective procedure for the treatment of symptomatic BPO, with low perioperative morbidity.

Take Home Message

Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a size-independent, minimally invasive treatment of benign prostatic obstruction (BPO). We report standardized perioperative complication rates using the modified Clavien classification system and early postoperative outcomes in 1080 patients undergoing ThuVEP due to BPO.

Keywords: Benign prostatic obstruction, Morbidity, Mortality, Tm:YAG, ThuVEP, Thulium vapoenucleation of the prostate, Vapoenucleation.

Footnotes

a Asklepios Hospital Barmbek, Department of Urology, Hamburg, Germany

b UMM, University Medical Center Mannheim, Department of Urology, Mannheim, Germany

lowast Corresponding author. Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany. Tel. +49 40 1818 82 8042; Fax: +49 40 1818 82 9829.

These authors contributed equally to this research.

z.star Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

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